Positioning of enhanced monofocal intraocular lenses between conventional monofocal and extended depth of focus lenses: a scoping review

Abstract

Background New intraocular lenses (IOLs) have emerged since the originally coined monofocal and multifocal IOLs. The extended depth of focus (EDoF) and enhanced monofocal IOLs (mono-EDoF) that have appeared in the last decade have caused some confusion in their classification. The aim of this review was to summarize the outcomes provided by mono-EDOF IOLs and to determine which of the endpoints, described by the American National Standard (ANSI) for EDoF IOLs, are fulfilled. Methods The MEDLINE, EMBASE, and WEB OF SCIENCE databases were searched. Two independent reviewers screened the studies for inclusion and data extraction. The search strategy was limited to studies published between 2020 and 2022, but not by language. The results are presented as a narrative summary accompanied by tables, in alignment with the objectives of this scoping review. Compliance with the endpoints for clinical outcomes described in the American National Standard Z80.35–2018 (ANSI) for EDoF lenses was checked and additional endpoints were defined. Results Two systematic reviews, 13 laboratory, 21 clinical, and two mixed studies were included. Tecnis Eyhance was the mono-EDOF with the highest volume of evidence to date. Although laboratory studies included other IOLs, clinical evidence for them is still scarce, with only one study of IsoPure compared to a standard monofocal IOL. Evidence in comparison to EDoF lenses is also scarce, even for Tecnis Eyhance, with only three studies including this lens in comparison to an EDoF lens. After evaluation of the ANSI criteria, agreement was found in the failure for the increase in depth of field equal to or greater than 0.5 D for a visual acuity (VA) level of 0.2 logMAR and none of the studies supported that the median monocular VA at intermediate distance was at least 0.2 logMAR. Conclusions Additional clinical evidence is required for other mono-EDOF IOLs beyond Tecnis Eyhance. Until the arrival of a standard classification, mono-EDOF should be better still classified as monofocal because the ANSI standards were not fully met.

Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens

“…It also provided similar distance vision performance, contrast sensitivity and photic phenomena compared to conventional monofocal IOLs [ 8 ]. However, as described by Fernandez et al [ 9 ] enhanced monofocal IOLs do not provide the range of vision required to satisfy the ANSI EDF criteria.…”

Optical and aberrometric evaluation of a new enhanced monofocal intraocular lens with isofocal optic design

“…Since 74% of the current evidence regarding EM-IOLs lenses comes from the Tecnis Eyhance lens (Johnson & Johnson Surgical Vision, jnjvi sionp ro. com/ ), 9 it is important to evaluate the behaviour of other lenses in terms of visual quality and aberrometric outcomes. The ISOPure lens (BVI medical, bvime dical.…”

“…Although some IOLs provide a limited increase in the range of vision, they do not meet the criteria established by the American Academy of Ophthalmology to be categorised as EDOF IOLs, 8 and so are termed enhanced monofocal intraocular lenses (EM‐IOLs). Since 74% of the current evidence regarding EM‐IOLs lenses comes from the Tecnis Eyhance lens (Johnson & Johnson Surgical Vision, http://jnjvisionpro.com/), 9 it is important to evaluate the behaviour of other lenses in terms of visual quality and aberrometric outcomes. The ISOPure lens (BVI medical, http://bvimedical.com/) is an EM‐IOL with a 100% refractive mechanism, with an optic design based on the isofocal concept, a patented polynomial technology 10…”

Using adaptive optics to optimize the spherical aberration of eyes implanted with EDOF and enhanced monofocal intraocular lenses

“…Enhanced monofocal IOL aims to bridge the gap in performance between standard monofocal IOLs and EDOF IOLs as the latter may provide better distance-corrected near visual acuity (VA). 2 For intermediate vision, both enhanced and EDOF IOLs provide similar performance among patients. 2 Although these IOLs provide excellent intermediate vision, the quality and quantity of near vision may be inadequate.…”

“…2 For intermediate vision, both enhanced and EDOF IOLs provide similar performance among patients. 2 Although these IOLs provide excellent intermediate vision, the quality and quantity of near vision may be inadequate. 3,4 Some patients may still need reading spectacles after implantation of EDOF IOLs.…”